|The Determinants of the HIV/AIDS Epidemics in Europe: held in conjunction with the 12th World AIDS Conference (UNAIDS, 1998, 44 p.)|
The profound societal changes that have swept across the countries of eastern Europe and Central Asia have created conditions that make them particularly vulnerable to the spread of HIV and STIs. Factors which are reported to have contributed to increased vulnerability to the spread of HIV/STIs in this and other regions include: widespread poverty; large gaps between the very wealthy few and an impoverished majority; migration due to economic hardship and civil strife, resulting in the disruption of households and family life; and deteriorating health and education services. What makes eastern Europe unique is that rapid socioeconomic changes appear to have been accompanied by a shift in ideology, from collectivism to individualism and consumerism, and by a massive increase in individual risk-taking in terms of unsafe sexual and drug use behaviors. Hypothesized linkages between socioeconomic change and individual vulnerability to HIV/STI in the region include the following:
· Entire communities that had been dependent on single industries have faced economic collapse. The most entrepreneurial citizens tend to start their own businesses, migrate, or resort to crime. New entrepreneurs may be at increased risk in terms of unsafe sexual and drug use situations and behaviors.
· Rapidly rising unemployment rates and the seeming uselessness of the older generations hard work have led to growing disillusionment, loss of purpose, and hopelessness among the young. Many youth seek relief through criminal activity or escape through drugs and alcohol.
· Social upheaval has led to massive increases in the number of children who no longer live with their parents. Several thousand or even tens of thousands of children live in the streets, in market places, or at railway stations in cities such as St. Petersburg. It is well known from past experience in other countries that street children are at particularly high risk for sexual exploitation, drug addiction, and HIV infection.
· The combination of easy access to, and strong demand for, illicit drugs has resulted in their consumption by a very large number of people. The individual risk of drug users contracting HIV infection is linked to local patterns of drug preparation, drug markets and distribution channels, and injecting practices.
· Huge disparities in income now exist, and there has been a particular deterioration in the economic situation of women. Power and money are concentrated in a small group, while those at the other end of the scale have little or nothing. Many women have resorted to sex work as a coping strategy.
· Men who have sex with men (MSM) are another population group that is particularly vulnerable to HIV/AIDS. Since there is a weak tradition of social behavioral research, especially on sexual issues, few scientific surveys exist on sexual preferences, practices, and lifestyles in the region, including on same-sex contacts.
· Prisons in eastern Europe are affected by the socioeconomic crisis in the same way other public services are. Prison inmates represent a larger proportion of the population here than in western Europe. The large segment of the population incarcerated in the Newly Independent States (NIS) is exposed to the increased risk of HIV infection associated with imprisonment resulting from sex between men, possible forced sex, and drug use.
· Changing social standards, or rather the vacuum left by the removal of old standards along with the challenging of taboos (e.g., discussion of sex, greater acceptance of homosexuality), may have contributed to the relaxation of sexual norms, to changes in sexual behaviors and growth in the number of persons engaging in casual and commercial sex.
Institutional factors associated with increased vulnerability to HIV and STIs include the lack of effective sex education, legislation which is not conducive to HIV prevention among vulnerable groups, and the lack of quality condoms at affordable prices in many countries. At the same time, a more supportive environment is being created through democratic processes, growth and development of NGOs and self-help groups, greater tolerance and acceptance of differing lifestyles, and greater access to information.